By Sterling C. Beard
Rep. Diane Black (R-Tenn.) is a woman of firsts.
She was the first member of her family to receive a degree in higher education, an A.D. in nursing from Anne Arundel Community College in 1971.
She was the first freshman member of the 112th Congress to have a bill become law, and she was one of only two freshmen appointed to the House Ways and Means Committee.
There's one thing she's already experienced ahead of many others, though, that she has no desire to see again: universal healthcare.
Black got into politics because of her opposition to TennCare, a statewide pilot program for universal coverage that was launched in 1994 as the Clinton White House was pushing for healthcare reform.
Its goal was to expand coverage to Tennesseans who were uninsured and those who had preexisting conditions. It was also supposed to help rein in the Tennessee Medicaid budget.
The program, still in existence today, covers approximately 1.2 million Tennesseans under a budget of $8 billion, according to the TennCare website.
But Black, who worked as a full-time nurse until her election to the Tennessee state Senate, says that the system has been plagued with issues like overuse since its launch.
One of her biggest issues with TennCare was its lack of limitations.
The program's initial 3-tier structure provided coverage for those eligible for Medicaid, for the uninsured, and for uninsurable people with preexisting conditions. Almost exactly one year after TennCare went into effect, the second tier was temporarily closed off to new enrollees because of massive enrollment.
Black says she saw the problems firsthand in her nursing work.
"People would consistently use an emergency room when they could have gone to either a walk-in clinic or waited to see a family practice doctor for minor things [such as] a sore throat, which really clogs up an emergency room," she said.
"I'd say, "You know, you maybe don't need to be in the emergency room. You could see your doctor tomorrow about this.' And they [would say], "Well I got to work tomorrow,' or "I got somewhere to go tomorrow so I really need to be seen today.'
"If you don't have skin in the game, then those are the kind of [decisions] you will make."
Unnecessary emergency room visits weren't the only problems that Black had with TennCare.
Oftentimes the recipients would hop from one doctor to another and would receive contra-indicating drugs, she said. As a result, the program didn't give quality, cost-effective care and quickly ran up a large tab with its swelling ranks.
"Having seen what was happening in this TennCare program to our state working in a hospital, working in healthcare, I recognized [it] was going to break our state, and I went to the legislature because of that," Black told The Hill.
After serving in the Tennessee House for six years, she was elected to the Tennessee Senate, where she rose to the position of Tennessee Republican Caucus Chairman. She also served as Vice-Chair of the Senate General Welfare, Health and Human Resources Committee, foreshadowing her more recent leadership positions amongst U.S. House freshmen.
"Working on healthcare issues for the 12 years that I served in the [Tennessee] legislature was really my forte."
Black's experience in the Tennessee legislature -- which she describes as a "training ground" for Congress -- paid off when she was elected in a landslide to represent Tennessee's 6th congressional district after the retirement of incumbent Democrat Bart Gordon.
She became the first freshman member of the 112th Congress to have a bill become law.
H.R. 2576 amended the Internal Revenue Code of 1986 to modify the calculation of modified adjusted gross income, thereby closing a loophole in the Patient Protection and Affordable Care Act that would have allowed those with higher incomes to receive a Medicaid subsidy.
"Medicaid is already one of those programs that is having a hard time being funded both at the federal and the state level. It is a program that is meant for people who are at the very lowest [income] level, in poverty, as a safety net for them," she said. "If you're giving those benefits to somebody at a much higher income [level], that does not make sense. [H.R. 2576] saved the American taxpayer $13 billion."
Black's pre-politics nursing career included time spent providing emergency room care, but also same-day surgery, recovery room nursing, home health nursing and diabetes education.
"I'd always wanted to be a nurse from the time I was four years old," said Black, a mother of three and grandmother of six.